The government's budget proposal for a general practice co-payment has been universally condemned since it was announced, and deservedly so. It is bad health policy.

At the request of the Prime Minister, the AMA developed an alternative co-payment model. Last week, we released that proposal. It aims to protect vulnerable groups in our community, while suggesting that where people can afford to contribute they should do so.

The AMA proposes a co-payment of $6.15 for concession card holders and those under 16 years of age, which would be paid for by the government, and not from their own pocket. Only non-concession patients over 16 years of age would be asked to make a co-payment of at least $6.15. This amount was chosen on the basis that it is the current GP bulk-billing incentive. The amount would be indexed.

The government has argued that the co-payment should be a price signal to reduce unnecessary visits to the doctor. However, as the government itself has modelled only a 1 per cent reduction in GP visits, the rationale behind the co-payment proposal is again confused.

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For a 1 per cent reduction in GP visits, a $7 co-payment on all patients seems like a very significant impost on society for a very, very modest return. It simply does not make sense.

What has become clear is that the government's $7 co-payment proposal is nothing more than an attempt to make the budget bottom line "look better".

The pre-election commitment to not cut health was always going to be a problem for the government. So, taking $20 billion out of health by 2020 and putting it into the Medical Research Future Fund (MRFF) allows the government to say that the money has been kept in health. It also, as the Finance Minister has finally articulated, means that the government can make debt look better because the MRFF will offset debt. Ingenious!

That is also the reason that the government can't accept the AMA's proposal.

As the AMA has said that we cannot accept a cut to the Medicare rebate, the AMA proposal does not save the government $3.5 billion from the cut to patients' Medicare rebates. It has only a very modest saving. However, the rationale behind the AMA's proposal is different.

For the opposition, this is an opportunity to capitalise on the government's intentions for Medicare – real or perceived. The opposition has stated that it will never support any GP co-payment. It has attacked the government for taking away our universal health system. However, they ignore the fact that almost 20 per cent of GP services are not bulk-billed but, instead, attract a significant co-payment.

For many people, the concept of universality means that everyone has access to healthcare using Medicare bulk-billing. However, universal access to care is not the same as access that is free of charge.

The AMA agrees that there is a role for free medical care for some patients in our society, particularly those for whom any sort of financial barrier to care would deny or deter them from accessing healthcare. We know that almost 6 per cent of adults already state that this is the case.

So, why has the AMA suggested a co-payment for patients who can afford to contribute? It is because if we continue to encourage a bulk-billing culture in general practice for all patients, the quality of general practice will suffer. Today, bulk-billing relies on an ever-dwindling Medicare rebate in real terms. Competitive pressures mean that GP consultation times are shorter and can only cover single issues.

The long-term sustainability of our healthcare system hinges on the ability of general practice to focus on prevention and manage chronic disease. Managing the burden of chronic disease is the greatest challenge for Australia's healthcare system. A modest co-payment, for those who can afford to contribute, will encourage the sort of quality general practice that we need to see, and which is so important in keeping patients well and out of more expensive hospital care.

It's an easy shot to paint the AMA and its members as only being interested in a "cash grab", as the Health Minister has done. In fact, the AMA has led the debate in relation to concerns about vulnerable patients in our community. The AMA has been consistent in its support for some co-payments, but also in its strong opposition to the government's co-payment proposal.

For many GPs, particularly those in suburban small practices or those in regional areas, their practices grapple with how to provide quality and comprehensive care for their patients in a competitive environment. If they don't bulk-bill, their patients go up the road to the bulk-billing clinic or they only attend when they have a serious problem that needs a longer consultation. This is why the AMA wants significant new investment in general practice.

While the AMA's proposal does result in an increase of funding for general practice of $580 million over three years (compared with the government's budget "windfall" of $480 million), it also protects vulnerable patients and children – and also excludes out of clinic services such as visits to residential aged care facilities.

This investment is not a pay rise for GPs. It is an investment in more staff and better facilities in general practice to further improve the quality of care and meet growing demand for GP services.

If practices are to gear up for the introduction of a co-payment next July, they will need information and plenty of notice. The government needs to put its model to Parliament for scrutiny and debate sooner rather than later.

If the government's co-payment is to be ditched completely, we will need an alternative plan to strengthen general practice.

The AMA's proposal does not make the government's debt level "look better". Rather, the AMA's proposal is about sustaining the healthcare system through investing in general practice, while maintaining access to affordable healthcare for everyone.

This is a universal healthcare system that will serve the community much longer than the stressed current model.

Associate Professor Brian Owler is the president of the Australian Medical Association.

62 comments so far

There are some Doctors guilty of overservicing, they look for 'vulnerable' patients to become regulars. This plan is not about curtailing this, merely supporting it. Many patients become adicted to the antidepresents the continually prescribe. The $7 charge for all will reduce the willingness of those addicted to presciption drugs, to remain those Dr.s regular clients.

Commenter

Kingstondude

Location

Malaysia atm

Date and time

August 27, 2014, 11:35PM

Professor Owler, what about people with chronic medical conditions who are not concession card holders? I have had Type 1 Diabetes for well over forty years and I am on an insulin pump. My sight, kidneys and limbs have been affected. I am not on any sort of concession card. I pay for eight full priced scripts, so that the $5 Pharmaceutical Benefits Scheme co-payment will put up my pharmacy bill of well over $200 each time I fill them by $40. I spend $200 each time I buy diabetic supplies such as canulas & insulin reservoirs. I pay $3,600 a year for custom made compression garments for my legs. I see multiple specialists, often paying hundreds of dollars a week in gaps. I have difficulty fighting off infections, and so have more than the average number of GP visits. Every year, both my GP and my specialists order a huge number of diagnostic tests, on which I am now destined to pay a $7 co-payment on each and every one. For many people with chronic diseases, medical expenses are already very high and these co=payments could be the straw that broke the camels back.

Commenter

Jill

Date and time

August 28, 2014, 10:57PM

Dr Owler, can you please explain how unemployed under 30's, who will be on zero income and will not have a concession card as they are not receiving a benefit, will be able to afford to see a GP, let alone have diagnostic tests done or pay for essential medicines? And what if they have a condition like cystic fibrosis, epilepsy or diabetes? Are they just going to fall through the cracks because they don't have a concession card?

Commenter

Brian

Date and time

August 28, 2014, 11:09PM

addiction to prescription drugs is a real addiction......$7 per visit is not going to deter people from getting their drugs...so they just end up poorer and still go to the doctor. Medibank is just practising extortion....they will put up their premiums where only the rich can pay and therefore only the rich can get into emergency units......this has to get blocked in the Senate for all time.

Commenter

JT

Date and time

August 29, 2014, 6:41AM

So who are these mysterious Doctors who overservice vulnerable patients? Who are they? Or perhaps you just make up facts to support an LNP policy (or criticize alternatives that expose the empty thoughts behind LNP policy)?

Commenter

Dean

Location

Sydney

Date and time

August 29, 2014, 8:07AM

@Kingstondude - so you reckon someone who is addicted to prescription drugs won't be willing to pay $7 to get those prescription drugs...right!

Commenter

jaci

Date and time

August 29, 2014, 8:28AM

No need to penalize the sick.If more money is needed then, in this great egalitarian country renowned for its sense of the fair go,with progressive taxation being one of the cornerstones of this,just increase the payment for everyone.Problem solved.

Commenter

nkelly

Date and time

August 27, 2014, 11:41PM

This co-payment will cause mayhem particularly to emergency departments. Will it improve the overall care of individuals? I doubt it. I suspect in the long term it will cost more due to individuals requiring treatment for more serious matters. In other words the revolving door phenomena we currently see in all hospitals and treatment facilities will just get worse.Mind you the AMA is no beacon of forward thinking either.Every time the bills increase, my diabetic 83YO previously large mother cuts back on diet (amongst other necessities) to make ends meet. Whatever additional funds we provide her, she stores and continues dieting. Her logic being it will just get worse, not better.?????I make no apologies when I state I feel nothing but contempt for the current administration and its flagrant disregard for the will and welfare of the people who elected them.

How about individuals who engage in nominated preventative treatment be unmolested by co-payments while the rest pay. Just a thought.

Commenter

Citizen

Location

Sunshine

Date and time

August 28, 2014, 2:53AM

If you want a real eye-opener, go back to the policy documents & discussion around the creation of Medibank #1. It was set up to ensure people like your mother got good medical care without going hungry. It was based on the now outmoded idea that a government's role was to care for the people & a recognition that some people needed more car than others. And the AMA hated it for that reason. To them, bulk billing has always been an anathema as they don't like to think of themselves as wage earners, employed by the taxpayers.

It is fashionable to discredit everything the Whitalm government did & blame them for a lot of things they didn't do or could not control, but they turned a semi-moribund, class ridden back water into a modern nation with a deep commitment to social justice. We seem to have gone full circle. Pity.

Commenter

Princess Panda

Date and time

August 28, 2014, 2:30PM

Brian Owler makes some great points. It's good the AMA recognise we need co-payments and their reasons for a change in culture is sound. Maybe the policy does need tweaking and Hockey and Abbott need to consult with industry a bit more, however the point remains co-payments need to be introduced.